<div id="pf1" class="pf w0 h0" data-page-no="1"><div class="pc pc1 w0 h0"><div class="c x0 y0 w1 h0"><div class="t m0 x1 h1 y1 ff1 fs0 fc0 sc0 lsf ws15">OSCE </div><div class="t m0 x2 h2 y2 ff1 fs0 fc1 sc0 ls10 ws0">1.<span class="ff2 ls0 ws15"> <span class="ff1 lsf">RITMO CARDÍACO REGULAR EM 2T </span></span></div><div class="t m0 x2 h1 y3 ff1 fs0 fc0 sc0 lsf ws15">B1= fechamento de tricúspide e mit<span class="blank _0"></span>ral<span class="blank _1"> </span> </div><div class="t m0 x2 h1 y4 ff1 fs0 fc0 sc0 lsf ws15">B2= fechamento de pulmonar e aórtico </div><div class="t m0 x2 h1 y5 ff1 fs0 fc0 sc0 lsf ws15">Entre b1 e b2 = sistólica </div><div class="t m0 x2 h1 y6 ff1 fs0 fc0 sc0 lsf ws15">B2 e b1 = diastólica </div><div class="t m0 x2 h2 y7 ff1 fs0 fc1 sc0 ls10 ws0">2.<span class="ff2 lsf ws15"> <span class="blank _2"></span><span class="ff1">RITMO CA<span class="ls11 ws1">RD</span>ÍACO REGULAR EM 2T <span class="ff3 ls1">\u2013</span> <span class="ls12 ws2">B3<span class="blank _0"></span><span class="lsf ws15"> </span></span></span></span></div><div class="t m0 x2 h1 y8 ff1 fs0 fc0 sc0 ls12 ws2">B3<span class="lsf ws15">: vibração de paredes ventriculares durant<span class="blank _0"></span>e a fase de enchimento rápido e </span></div><div class="t m0 x2 h1 y9 ff1 fs0 fc0 sc0 lsf ws15">desaceleração das valvas AV <span class="ff3 ls1">\u2013</span> sensibilização de B3 <span class="ff3 ls1">\u2013</span> <span class="ls10 ws0">1.</span> Foco mitral, 2. </div><div class="t m0 x2 h1 ya ff1 fs0 fc0 sc0 lsf ws15">Semidecubito lateral esquerdo, 3. Expiração, 4. Campanula. </div><div class="t m0 x2 h3 yb ff4 fs0 fc0 sc0 lsf ws15">PROTOSDIASTÓLICO </div><div class="t m0 x2 h3 yc ff4 fs0 fc0 sc0 lsf ws3">Fisiológico<span class="ff1 ws15">:<span class="blank _1"> </span> Ge<span class="blank _0"></span>stante/ C<span class="blank _0"></span>riança (Estado hip<span class="ls1 ws4">er</span>volêmico <span class="ls11">: </span>Hipertrofia Atrial, Piora </span></div><div class="t m0 x2 h3 yd ff1 fs0 fc0 sc0 lsf ws15">estenose mitral, 4º arco, duplo contorno)<span class="ls13">. </span><span class="ff4 ws5">Patológico</span>: <span class="ls13 ws6">IC</span> </div><div class="t m0 x3 h2 ye ff1 fs0 fc1 sc0 ls10 ws0">3.<span class="ff2 ls2 ws15"> <span class="ff1 lsf">RITMO CARDIACO REGUL<span class="blank _1"> </span>AR <span class="blank _0"></span>EM 3T <span class="ff3 ls1">\u2013</span> <span class="ls12 ws2">B4</span> </span></span></div><div class="t m0 x2 h1 yf ff1 fs0 fc0 sc0 ls12 ws2">B4<span class="lsf ws15">: <span class="blank _3"> </span>Enchimento <span class="blank _3"> </span>refratário <span class="blank _3"> </span>do<span class="blank _1"> </span> <span class="blank _3"> </span>ventrículo <span class="blank _3"> </span>(AT<span class="blank _1"> </span>RASADO). <span class="blank _3"> </span>Tem <span class="blank _3"> </span>haver <span class="blank _4"> </span>com </span></div><div class="t m0 x2 h3 y10 ff4 fs0 fc0 sc0 lsf ws15">SOBRECARGA DE PRE<span class="blank _1"> </span>SSÃO NO ÁTRIO<span class="ff1 ls13">. S<span class="lsf">ístole Atrial com<span class="blank _1"> </span> complacência ventricular </span></span></div><div class="t m0 x2 h1 y11 ff1 fs0 fc0 sc0 lsf ws15">reduzida. </div><div class="t m0 x2 h3 y12 ff4 fs0 fc0 sc0 lsf ws15">TELEDIASTÓLICO </div><div class="t m0 x2 h3 y13 ff4 fs0 fc0 sc0 lsf ws3">Fisiológico<span class="ff1 ws15">:<span class="blank _1"> </span> <span class="blank _0"></span>Hipertrofia do a<span class="blank _0"></span>tleta<span class="ls13">. </span><span class="ff4 ws7">Patológic<span class="blank"> </span>o<span class="blank"> </span></span>: HAS, hipert<span class="blank _0"></span>rofia concêntrica do </span></div><div class="t m0 x2 h3 y14 ff1 fs0 fc0 sc0 lsf ws5">ventrículo<span class="ls13 ws15">. <span class="ff4 lsf">NUNCA TERÁ B4 = FIB<span class="blank _0"></span>RILAÇÃO ATRIAL<span class="blank _1"> </span> </span></span></div><div class="t m0 x3 h2 y15 ff1 fs0 fc1 sc0 ls10 ws0">4.<span class="ff2 ls2 ws15"> <span class="ff1 lsf">RITMO CARDÍACO IRREGULAR EM 2T </span></span></div><div class="t m0 x2 h3 y16 ff4 fs0 fc0 sc0 lsf ws15">FIBRILAÇÃO ATRIAL/AUSÊNCIA DE SÍSTOLE/AUSÊNCIA DE B4 </div><div class="t m0 x2 h1 y17 ff1 fs0 fc0 sc0 lsf ws15">Ocorre em Estenose Mitral (Ruflar diast<span class="blank _0"></span>ólico), Edema agudo de<span class="blank _1"> </span> pulmão, mulher </div><div class="t m0 x2 h1 y18 ff1 fs0 fc0 sc0 lsf ws15">em idade fértil <span class="ls14 ws8">20<span class="blank _0"></span><span class="lsf ws15">-4<span class="blank _0"></span>0 anos. </span></span></div><div class="t m0 x1 h4 y19 ff4 fs0 fc0 sc0 ls10 ws9">5.<span class="ff5 lsf ws15"> <span class="blank _2"></span><span class="ff1 fc1">RITMO CARDÍACO REGULAR EM 2T COM SOPRO SISTÓLICO E HIPOFONESE DE B1<span class="ls13">. </span></span></span></div><div class="t m0 x2 h3 y1a ff4 fs0 fc0 sc0 lsf ws15">SOPRO + B2<span class="lsb">. </span>INSUFICIÊNCIA MITRAL OU TRICÚSPIDE </div><div class="t m0 x4 h3 y1b ff4 fs0 fc0 sc0 lsf ws15">Possível I.M, RARAMENTE I.T, MELHORES EM FOCOS MITRAL E TRICUSPIDE. </div><div class="t m0 x2 h3 y1c ff4 fs0 fc0 sc0 lsf ws15">Manobra de Riveiro Carvalho Posi<span class="blank _0"></span>tivo<span class="ff1"> = na inspiração profund<span class="blank _0"></span>a, diminui a<span class="blank _0"></span> pressão </span></div><div class="t m0 x2 h1 y1d ff1 fs0 fc0 sc0 lsf ws15">intratorá<span class="blank _0"></span>cica, a<span class="blank _0"></span>umentando o <span class="blank _0"></span>som <span class="blank _0"></span>de t<span class="blank _0"></span>ricúspide. <span class="blank _0"></span>É ut<span class="blank _0"></span>ilizado <span class="blank _0"></span>para <span class="blank _0"></span>diferencia<span class="blank _0"></span>r a <span class="blank _0"></span><span class="ls13 ws6">I.<span class="ls15 ws15">M <span class="blank _0"></span><span class="lsf">de<span class="blank _0"></span> </span></span></span></div><div class="t m0 x2 h3 y1e ff1 fs0 fc0 sc0 lsf ws15">I.T. <span class="ff4">Manobra de Handgrip = </span>aumenta RVP e intensifica sopros Aórtico e M<span class="blank _0"></span>itral.<span class="blank _1"> </span> </div><div class="t m0 x2 h3 y1f ff4 fs0 fc0 sc0 lsf ws15">*Elevação <span class="blank"> </span>do<span class="blank _1"> </span>s <span class="blank"> </span>membros <span class="blank"> </span>inferiores, <span class="blank"> </span>posição <span class="blank"> </span>de <span class="blank"> </span>agacham<span class="blank _1"> </span>ento, <span class="blank"> </span>exercício <span class="blank"> </span>físico </div><div class="t m0 x2 h3 y20 ff4 fs0 fc0 sc0 lsf ws15">aumenta som de <span class="blank _1"> </span>tricús<span class="blank _0"></span>pide. </div><div class="t m0 x1 h4 y21 ff4 fs0 fc0 sc0 ls10 ws9">6.<span class="ff5 lsf ws15"> <span class="blank _2"></span><span class="ff1 fc1">RITMO CARDÍACO REGULAR EM 2T COM SOPRO SISTÓLICO E HIPOFONESE DE B2 - </span></span></div><div class="t m0 x2 h3 y22 ff1 fs0 fc1 sc0 lsf ws15">B1+SOPRO+B2. <span class="ff4 fc0">Estenose Aórtica </span></div><div class="t m0 x2 h3 y23 ff4 fs0 fc0 sc0 lsf ws5">Aumenta<span class="ff1 ws15"> = Agachado; pernas elevadas; tórax p/ frente </span></div><div class="t m0 x2 h3 y24 ff4 fs0 fc0 sc0 lsf wsa">Diminui<span class="ff1 ws15">: V<span class="blank _1"> </span>alsalva; <span class="blank _0"></span>Ortostase; Pé </span></div><div class="t m0 x2 h3 y25 ff4 fs0 fc0 sc0 lsf ws15">SOPRO AÓRTICO = IRRADIA P/ CARÓTIDA </div><div class="t m0 x1 h2 y26 ff1 fs0 fc1 sc0 ls10 ws0">7.<span class="ff2 ls3 ws15"> <span class="ff1 lsf">ESTRIDOR </span></span></div><div class="t m0 x3 h2 y27 ff6 fs0 fc0 sc0 lsf wsb">\u2022<span class="ff2 ls4 ws15"> <span class="ff1 lsf">Obstrução de vias aéreas altas </span></span></div><div class="t m0 x2 h2 y28 ff6 fs0 fc0 sc0 lsf wsb">\u2022<span class="ff2 ls5 ws15"> <span class="ff1 ls16 wsc">Fi<span class="lsf ws15">nal da Inspiração<span class="ls17">/ </span>Colabamento de Traqueia<span class="blank _1"> </span>/ Pós intubação prolongada </span></span></span></div><div class="t m0 x2 h2 y29 ff6 fs0 fc0 sc0 lsf wsb">\u2022<span class="ff2 ls5 ws15"> <span class="ff1 lsf">Traqueomalacia/C<span class="blank _0"></span>âncer de traque<span class="ls15">ia <span class="blank _1"> </span></span> </span></span></div><div class="t m0 x2 h2 y2a ff1 fs0 fc1 sc0 ls10 ws0">8.<span class="ff2 ls0 ws15"> <span class="ff1 lsf">Estertor Grosso <span class="ff3 ls1">\u2013</span> Pneumo </span></span></div><div class="t m0 x2 h2 y2b ff6 fs0 fc0 sc0 lsf wsb">\u2022<span class="ff2 ls6 ws15"> <span class="ff1 lsf">DPOC/Pneumonia/Bronqueolite/C<span class="blank _0"></span>OVID </span></span></div><div class="t m0 x2 h2 y2c ff6 fs0 fc0 sc0 lsf wsb">\u2022<span class="ff2 ls6 ws15"> <span class="ff1 lsf">Início da Insp. e toda<span class="blank _0"></span> a expiração<span class="ls13">. A</span>umenta secreção e muco </span></span></div><div class="t m0 x2 h2 y2d ff1 fs0 fc1 sc0 ls10 ws0">9.<span class="ff2 lsf ws15"> <span class="blank _2"></span><span class="ff1">SIBILO </span></span></div><div class="t m0 x2 h2 y2e ff6 fs0 fc0 sc0 lsf wsb">\u2022<span class="ff2 ls6 ws15"> <span class="ff1 lsf">Obstrução de pequenas vias aéreas </span></span></div><div class="t m0 x2 h2 y2f ff6 fs0 fc0 sc0 lsf wsb">\u2022<span class="ff2 ls6 ws15"> <span class="ff1 lsf">Expiratório </span></span></div><div class="t m0 x2 h2 y30 ff6 fs0 fc0 sc0 lsf wsb">\u2022<span class="ff2 ls6 ws15"> <span class="ff1 lsf">Unilateral<span class="blank _0"></span> <span class="ff3 ls1">\u2013</span> Criança = broncoaspiração corpo estranho,broncofonia. Idoso = </span></span></div><div class="t m0 x5 h1 y31 ff1 fs0 fc0 sc0 lsf ws15">Câncer de pulmão. </div><div class="t m0 x2 h2 y32 ff6 fs0 fc0 sc0 lsf wsb">\u2022<span class="ff2 ls6 ws15"> <span class="ff1 lsf">Bilateral<span class="blank _0"></span> - Asma </span></span></div><div class="t m0 x1 h3 y33 ff4 fs0 fc2 sc0 lsf ws15">PNEUMONIA </div><div class="t m0 x1 h3 y34 ff4 fs0 fc0 sc0 lsf ws5">FREMITO<span class="ff1 ws15">:<span class="blank _1"> </span> A<span class="blank _0"></span>UMENTADO </span></div><div class="t m0 x1 h3 y35 ff4 fs0 fc0 sc0 ls18 wsd">AU<span class="lsf ws5">SCULTA<span class="ff1 ws15">: AUMENTA SOM, ESTERTOR<span class="blank _1"> </span> GR<span class="blank _0"></span>OSSO, SOPRO TUBÁRIO, BRONO<span class="blank _1"> </span>F<span class="blank _0"></span>ONIA </span></span></div><div class="t m0 x1 h3 y36 ff4 fs0 fc0 sc0 lsf ws5">RUALT<span class="ff1 ws15">: DIMINUIDO </span></div><div class="t m0 x1 h3 y37 ff4 fs0 fc0 sc0 lsf ws5">PERCUSSÃO<span class="ff1 ws15">: SOM MACIÇO E SUBMACIÇO. </span></div><div class="t m0 x1 h3 y38 ff4 fs0 fc2 sc0 lsf ws15">DERRAME PLEURAL </div><div class="t m0 x1 h3 y39 ff4 fs0 fc0 sc0 lsf ws5">FREMITO:<span class="ff1 ws15"> D<span class="blank _1"> </span>IMIN<span class="blank _0"></span>UIDO OU ABOLIDO </span></div><div class="t m0 x6 h3 y1 ff4 fs0 fc0 sc0 lsf ws5">AUSCULTA<span class="ff1 ws15">: MURMURIO VESICULAR ABOL<span class="blank _1"> </span>I<span class="blank _0"></span>DO </span></div><div class="t m0 x6 h3 y3a ff4 fs0 fc0 sc0 lsf ws5">RUALT<span class="ff1 ws15">: DIMINUIDO NA BASE </span></div><div class="t m0 x6 h3 y3b ff4 fs0 fc0 sc0 lsf ws5">PERCUSSÃO<span class="ff1 ws15">: SOM MACIÇO OU SUBMACIÇO </span></div><div class="t m0 x6 h3 y3c ff4 fs0 fc2 sc0 lsf ws15">PNEUMOTÓRAX </div><div class="t m0 x6 h3 y3d ff4 fs0 fc0 sc0 lsf ws5">FREMITO<span class="ff1 ws15">:<span class="blank _1"> </span> AB<span class="blank _0"></span>OLIDO OU DIMINUIDO </span></div><div class="t m0 x6 h3 y3e ff4 fs0 fc0 sc0 lsf ws5">AUSCULTA<span class="ff1 ws15">: M.V. ABOLIDO </span></div><div class="t m0 x6 h3 y3f ff4 fs0 fc0 sc0 lsf ws5">RUALT<span class="ff1 ws15">: DIMINUIDO </span></div><div class="t m0 x6 h3 y40 ff4 fs0 fc0 sc0 lsf ws5">PERCUSSÃO<span class="ff1 ws15">: SOM TIMPÂNICO </span></div><div class="t m0 x6 h3 y41 ff4 fs0 fc2 sc0 lsf ws15">DPOC </div><div class="t m0 x6 h3 y42 ff4 fs0 fc0 sc0 lsf ws5">FREMITO<span class="ff1 ws15">:<span class="blank _1"> </span> <span class="blank _0"></span>DIMINUIDO </span></div><div class="t m0 x6 h3 y43 ff4 fs0 fc0 sc0 lsf ws5">AUSCULTA<span class="ff1 ws15">: M.V. DIMINUIDO </span></div><div class="t m0 x6 h3 y44 ff4 fs0 fc0 sc0 lsf ws5">RUALT<span class="ff1 ws15">: DIMINUIDO </span></div><div class="t m0 x6 h3 y45 ff4 fs0 fc0 sc0 lsf ws5">PERCUSSÃO<span class="ff1 ws15">: HIPERSONORIDADE </span></div><div class="t m0 x6 h3 y46 ff4 fs0 fc2 sc0 lsf ws15">ASMA </div><div class="t m0 x6 h3 y47 ff4 fs0 fc0 sc0 lsf ws5">FREMITO<span class="ff1 ws15">:<span class="blank _1"> </span> <span class="blank _0"></span>DIMINUIDO </span></div><div class="t m0 x6 h3 y48 ff4 fs0 fc0 sc0 lsf ws5">AUSCULTA<span class="ff1 ws15">: M.V. DIMINUIDO, SIBILO, RONCOS </span></div><div class="t m0 x6 h3 y49 ff4 fs0 fc0 sc0 lsf ws5">RUALT<span class="ff1 ws15">: DIMINUIDO </span></div><div class="t m0 x6 h3 y4a ff4 fs0 fc0 sc0 lsf ws5">PERCUSSÃO<span class="ff1 ws15">: HIPERSONORIDADE, SOM CLARO PULMONAR </span></div><div class="t m0 x6 h3 y4b ff4 fs0 fc2 sc0 lsf ws15">ATELECTASIA </div><div class="t m0 x6 h3 y4c ff4 fs0 fc0 sc0 lsf ws5">FREMITO<span class="ff1 ws15">:<span class="blank _1"> </span> <span class="blank _0"></span>DIMINUIDO </span></div><div class="t m0 x6 h3 y4d ff4 fs0 fc0 sc0 lsf ws5">AUSCULTA<span class="ff1 ws15">: SONS RESPIRATORIOS ABOLIDOS </span></div><div class="t m0 x6 h3 y4e ff4 fs0 fc0 sc0 lsf ws5">RUALT<span class="ff1 ws15">: DIMINUIDO </span></div><div class="t m0 x6 h3 y4f ff4 fs0 fc0 sc0 lsf ws5">PERCUSSÃO<span class="ff1 ws15">: SOM SUBMACIÇO (REGIÃO DE COLABAMENTO) </span></div><div class="t m0 x6 h3 y50 ff4 fs0 fc3 sc0 lsf ws15">SINAL <span class="blank _1"> </span>DE<span class="blank _1"> </span> <span class="blank _1"> </span>LEVINE<span class="blank _1"> </span><span class="ff1 fc0">: <span class="blank _1"> </span>Paciente <span class="blank _5"> </span>coloca <span class="blank _1"> </span>o <span class="blank _5"> </span>punho <span class="blank _5"> </span>cerrado <span class="blank _5"> </span>sobre <span class="blank _5"> </span>o <span class="blank _1"> </span>tórax, <span class="blank _5"> </span>ao <span class="blank _1"> </span>s<span class="blank _1"> </span>e <span class="blank _1"> </span>queixar <span class="blank _5"> </span>de </span></div><div class="t m0 x6 h1 y51 ff1 fs0 fc0 sc0 lsf ws15">dor torácica. C<span class="blank _0"></span>aracterístico da isquemia miocárdica. Sinal patognomônico de angina.<span class="blank _1"> </span> </div><div class="t m0 x6 h3 y52 ff4 fs0 fc3 sc0 lsf ws15">FUNÇÃO <span class="blank _6"></span>DO <span class="blank _6"></span>SI<span class="blank _1"> </span>STEMA <span class="blank _0"></span>LINFATICO<span class="ff1 fc0 ls11">: <span class="blank _6"></span><span class="lsf">Drenagem de<span class="blank _0"></span> <span class="blank _6"></span>sub<span class="ls19 wse">st</span>âncias <span class="blank _0"></span>e <span class="blank _6"></span>defesa <span class="blank _0"></span><span class="ff3 ls1">\u2013<span class="ff1 lsf"> <span class="blank _6"></span>sistema <span class="blank _0"></span>imune </span></span></span></span></div><div class="t m0 x6 h5 y53 ff4 fs1 fc3 sc0 lsf ws15">LINFOIDES <span class="blank _6"></span>PRIMARI<span class="blank _1"> </span>OS<span class="ff1 fs0 fc0 ls11">: <span class="blank _6"></span><span class="lsf">onde <span class="blank _6"></span>s<span class="blank _1"> </span>e <span class="blank _6"></span>originam <span class="blank _0"></span>ou <span class="blank _6"></span>s<span class="blank _1"> </span>e <span class="blank _6"></span>diferenciam l<span class="blank _0"></span>infócitos: <span class="blank _0"></span>Timo <span class="blank _0"></span>e <span class="blank _6"></span>Medula </span></span></div><div class="t m0 x6 h1 y54 ff1 fs0 fc0 sc0 lsf ws15">Óssea Hematogênica </div><div class="t m0 x6 h3 y55 ff4 fs0 fc3 sc0 lsf ws15">LINFOIDES <span class="blank _7"> </span>SECUNDARIOS<span class="ff1 fc0 ls11">: <span class="blank _7"> </span><span class="lsf">funções <span class="blank _7"> </span>de <span class="blank _7"> </span>reconheciment<span class="blank _0"></span>o <span class="blank _8"> </span>de <span class="blank _7"> </span>antígenos <span class="blank _7"> </span>e <span class="blank _8"> </span>de </span></span></div><div class="t m0 x6 h1 y56 ff1 fs0 fc0 sc0 lsf ws15">desencadeamento de respostas imunitárias: linfonodos e baço. </div><div class="t m0 x6 h3 y57 ff4 fs0 fc3 sc0 lsf ws5">PNEUMONIA<span class="ff1 fc0 ls11 ws15">: <span class="blank _5"> </span><span class="lsf">Doença <span class="blank _9"> </span>inflamat<span class="blank _0"></span>oria <span class="blank _5"> </span>aguda, <span class="blank _9"> </span>infecciosa <span class="blank _5"> </span>que <span class="blank _9"> </span>aco<span class="blank _1"> </span>mete <span class="blank _5"> </span>o <span class="blank _9"> </span>espaço <span class="blank _9"> </span>aéreo, </span></span></div><div class="t m0 x6 h1 y58 ff1 fs0 fc0 sc0 lsf ws15">parenquima. Causada por ví<span class="blank _0"></span>rus, bactérias ou fungos. </div><div class="t m0 x6 h3 y59 ff4 fs0 fc3 sc0 lsf ws5">ICTUS<span class="ff1 fc0 ls11 ws15">: <span class="lsf">Ictus localizado no 5° E.I.E na<span class="blank _1"> </span> linha hemiclavicular; dependendo do bió<span class="blank _1"> </span>tipo do </span></span></div><div class="t m0 x6 h1 y5a ff1 fs0 fc0 sc0 lsf ws15">paciente. LEMA. L(localização<span class="blank _0"></span>, visibilidade e pal<span class="blank _0"></span>pação do ictus). E (usar polpa digital 1 </div><div class="t m0 x6 h1 y5b ff1 fs0 fc0 sc0 lsf ws15">ou <span class="blank"> </span>2). <span class="blank"> </span>M(com <span class="blank _a"> </span>mobilidade <span class="blank"> </span>ou <span class="blank"> </span>s<span class="blank _1"> </span>em <span class="blank"> </span>mobilidade).A(<span class="ff3">amplitude <span class="blank _a"> </span>\u201ctamanho\u201d <span class="blank"> </span>deve <span class="blank _a"> </span>ser </span></div><div class="t m0 x6 h1 y5c ff1 fs0 fc0 sc0 lsf ws15">fisiológica ou patológica<span class="ls1a wsf">).</span> </div><div class="t m0 x6 h3 y5d ff4 fs0 fc3 sc0 lsf ws15">PALPAÇÃ<span class="blank _0"></span>O <span class="blank _6"></span>DO PULSO <span class="blank _6"></span>DA <span class="blank _0"></span>AORTA <span class="blank _6"></span>ABDOMINAL<span class="ff1 fc0 ls11">: <span class="blank _6"></span><span class="lsf">P<span class="blank _1"> </span>aciente <span class="blank _6"></span>em <span class="blank _0"></span>decúbito <span class="blank _6"></span>dorsal, <span class="blank _0"></span>fazendo </span></span></div><div class="t m0 x6 h1 y26 ff1 fs0 fc0 sc0 lsf ws15">leve flexão das coxas sobre a bacia;Palpável acima do umbigo; <span class="blank _1"> </span>(região periumbilical)<span class="ls1b">; </span></div><div class="t m0 x6 h1 y5e ff1 fs0 fc0 sc0 lsf ws15">Não palpável abaixo do umbigo (Se palpável<span class="blank _0"></span> é um provável Aneuris<span class="blank _1"> </span>ma de Aorta<span class="ls1a wsf">).</span> </div><div class="t m0 x6 h3 y5f ff4 fs0 fc3 sc0 lsf ws15">SONS <span class="blank _b"> </span>PULMONARES <span class="blank _b"> </span>NORMAIS<span class="ff1 fc0 ls11">: <span class="blank _b"> </span><span class="lsf">som <span class="blank _c"> </span>traqueal, <span class="blank _b"> </span>brônquico, <span class="blank _b"> </span>Murmúrio <span class="blank _b"> </span>vesicular<span class="ls1c">, </span></span></span></div><div class="t m0 x6 h1 y60 ff1 fs0 fc0 sc0 lsf ws15">broncovesicular. </div><div class="t m0 x6 h6 y61 ff4 fs1 fc3 sc0 lsf ws15">JANELA <span class="blank _6"></span>DE <span class="blank _0"></span>SCHA<span class="blank _0"></span>MROTH/<span class="fs2"> <span class="blank _6"></span><span class="fs1">ba<span class="blank _1"> </span>queteamento <span class="blank _0"></span>digital/ <span class="blank _6"></span>HIPOCRATISMO<span class="blank _0"></span> <span class="blank _6"></span>DIG<span class="blank _1"> </span>ITAL<span class="ff1 fs0 fc0 ls11">: <span class="lsf">sinal<span class="blank _0"></span> <span class="blank _6"></span>da </span></span></span></span></div><div class="t m0 x6 h1 y62 ff1 fs0 fc0 sc0 lsf ws15">unha que <span class="blank _1"> </span>indica doença <span class="blank _1"> </span>sistêmica associada <span class="blank _1"> </span>a transtornos <span class="blank _1"> </span>pul<span class="blank _0"></span>monar, cardiovascular, </div><div class="t m0 x6 h1 y63 ff1 fs0 fc0 sc0 lsf ws15">neoplásica, infecciosa. </div><div class="t m0 x6 h3 y64 ff4 fs0 fc3 sc0 lsf ws15">LOCALIZAÇÃO DO PULSO <span class="blank _1"> </span>RADIAL<span class="ff1 fc0 ls11">: <span class="lsf">E<span class="blank _1"> </span>ntre o proces<span class="blank _1"> </span>so <span class="blank _1"> </span>estilóide do rádio <span class="blank _1"> </span>e o <span class="blank _1"> </span>tendão do </span></span></div><div class="t m0 x6 h1 y65 ff1 fs0 fc0 sc0 lsf ws15">flexor longo do pol<span class="blank _0"></span>egar. </div><div class="t m0 x6 h3 y66 ff4 fs0 fc3 sc0 lsf ws15">POSIÇÕES PARA <span class="blank _0"></span>SE <span class="blank _0"></span>AFERIR PA <span class="blank _0"></span>EM GESTANTE<span class="ff1 fc0">: Decúbito l<span class="blank _0"></span>ateral esquerdo <span class="blank _0"></span>ou <span class="blank _0"></span>sentada.<span class="blank _1"> </span> </span></div><div class="t m0 x6 h3 y67 ff4 fs0 fc3 sc0 lsf ws15">SENSIBILIZA <span class="blank _d"> </span>A <span class="blank _d"> </span>AUSCULTA <span class="blank _e"> </span>DO <span class="blank _e"> </span>ATR<span class="blank _1"> </span>ITO <span class="blank _e"> </span>PERICARDIO<span class="ff1 fc0">:<span class="blank _1"> </span>Inclinaçã<span class="blank _0"></span>o <span class="blank _e"> </span>e <span class="blank _d"> </span>anteriorização <span class="blank _e"> </span>do </span></div><div class="t m0 x6 h1 y68 ff1 fs0 fc0 sc0 lsf ws15">torax ,na ex<span class="blank _0"></span>piração no foco mitral. </div><div class="t m0 x6 h3 y69 ff4 fs0 fc3 sc0 lsf ws15">MODELOS PARA PERCUSSÃO<span class="ff1 fc0">: Maciço/Fígado,S<span class="blank _0"></span>ubmaciço/área </span></div><div class="t m0 x6 h1 y6a ff1 fs0 fc0 sc0 lsf ws15">precordial,Timpânico/região do epi<span class="blank _0"></span>gástrio (espaço de traube / baço) </div><div class="t m0 x6 h3 y6b ff4 fs0 fc3 sc0 lsf ws15">PULSO TARDUS PARVUS<span class="ff1 fc0">:uma pulsação lenta para subir e descer".Pulso fininho, está </span></div><div class="t m0 x6 h1 y6c ff1 fs0 fc0 sc0 lsf ws15">passando menos sangue<span class="ls13">. </span>E<span class="blank _1"> </span>STEN<span class="blank _0"></span>OSA AORTICA </div><div class="t m0 x6 h3 y6d ff4 fs0 fc3 sc0 lsf ws15">PULSO MARTELO DÁGUA<span class="ff1 fc0 ls11">: <span class="lsf">Pulso mais cheio e volumoso<span class="ls13">. </span>V.E contrai com o sangue </span></span></div><div class="t m0 x6 h1 y6e ff1 fs0 fc0 sc0 lsf ws15">que vem do A.E e com o sangue que regurgita da AORTA, deixando os vasos mais </div><div class="t m0 x6 h1 y6f ff1 fs0 fc0 sc0 lsf ws15">cheios. INSUFICIÊNCIA AORTICA. </div><div class="t m0 x7 h3 y1 ff4 fs0 fc3 sc0 lsf ws15">PULSO PARADOXAL<span class="ff1 fc0">: TAMPONAMENTO CARDIACO </span></div><div class="t m0 x7 h5 y2 ff4 fs1 fc3 sc0 lsf ws15">PULSO ALTERNAN<span class="blank _0"></span>S<span class="ff1 fs0 fc0 ls11">: <span class="lsf">alternância<span class="blank _0"></span> de força de contração do coração/sístole que </span></span></div><div class="t m0 x7 h1 y3 ff1 fs0 fc0 sc0 lsf ws15">promove um volume maior seguida de uma próxi<span class="blank _0"></span>ma seguida de um volume menor. </div><div class="t m0 x7 h1 y70 ff1 fs0 fc0 sc0 lsf ws15">Ocorre em situações de miocárdio comprometido. INSUFICIENCIA CARDÍACA. - <span class="lsb ws10">VE</span> </div><div class="t m0 x7 h3 y71 ff4 fs0 fc3 sc0 lsf ws15">PULSO FILIFORME<span class="ff1 fc0">: é um tipo de pulso ao mesmo tempo de pequena amplitude e </span></div><div class="t m0 x7 h1 y72 ff1 fs0 fc0 sc0 lsf ws15">mole. Indica quase sempre colapso circulatório perif<span class="blank _0"></span>érico. Não<span class="blank _1"> </span> confundir com pulso </div><div class="t m0 x7 h1 y73 ff1 fs0 fc0 sc0 lsf ws15">parvus </div><div class="t m0 x7 h3 y74 ff4 fs0 fc3 sc0 lsf ws15">PULSO BÍFIDO<span class="ff1 fc0">: Mais detect<span class="blank _0"></span>ado na artéria carótida. Estenose a<span class="blank _1"> </span>órtica combinada<span class="blank _0"></span> com </span></div><div class="t m0 x7 h1 y75 ff1 fs0 fc0 sc0 lsf ws15">Insuficiência mitral </div><div class="t m0 x7 h3 y76 ff4 fs0 fc0 sc0 lsf ws15">Insuficiência AÓRTICA- B2: Hipofonética<span class="ls1d">; </span>Insuficiência Tricúspide- B1: </div><div class="t m0 x7 h3 y77 ff4 fs0 fc0 sc0 lsf ws11">Hipofonética<span class="ls1d ws15">; <span class="lsf">Insuficiência Pulmonar- B2: Hipofonética. </span></span></div><div class="t m0 x7 h3 y78 ff4 fs0 fc3 sc0 lsf ws15">TIPOS DE DIAGNOSTICOS DADO EM UMA ANAMNESE<span class="ff1 fc0">: ET<span class="blank _1"> </span>IOL<span class="blank _0"></span>ÓGICO,FUNCIONAL, </span></div><div class="t m0 x7 h1 y79 ff1 fs0 fc0 sc0 lsf ws15">SINDRÔMICO, ANATÔMI<span class="ls1e ws12">CO<span class="blank"> </span></span>. </div><div class="t m0 x7 h3 y7a ff4 fs0 fc3 sc0 lsf ws11">SINCOPE<span class="ff1 fc0 ws15">: Perda súbita e transitória da<span class="blank _0"></span> consciência secundária a hipoperfusão </span></div><div class="t m0 x7 h1 y7b ff1 fs0 fc0 sc0 lsf ws15">cerebral difusa. </div><div class="t m0 x7 h3 y7c ff4 fs0 fc3 sc0 lsf ws15">TRIADE CLINICA DO TROMBOEMBOLISMO PULMONAR<span class="ff1 fc0">: 1. Dor Pleurítica 2. di<span class="blank _0"></span>spneia </span></div><div class="t m0 x7 h1 y7d ff1 fs0 fc0 sc0 lsf ws15">3. Hemoptise. </div><div class="t m0 x7 h3 y7e ff4 fs0 fc3 sc0 lsf ws15">TIPOS DE RITMOS RESPIRATORIO<span class="ff1 fc0 ls11">: <span class="lsf">Dispneia(dificuldade para respirar), Ortopnéia(é a </span></span></div><div class="t m0 x7 h1 y7f ff1 fs0 fc0 sc0 lsf ws15">dispnéia que <span class="blank _1"> </span>impede o <span class="blank _1"> </span>paciente <span class="blank _1"> </span>de ficar<span class="blank _1"> </span> deitado <span class="blank _1"> </span>e o <span class="blank _1"> </span>obriga <span class="blank _1"> </span>a <span class="blank _1"> </span>assentar<span class="blank _1"> </span>-se ou <span class="blank _1"> </span>ficar de<span class="blank _1"> </span> </div><div class="t m0 x7 h1 y80 ff1 fs0 fc0 sc0 lsf ws15">pé <span class="blank _f"> </span>para <span class="blank _f"> </span>obter <span class="blank _f"> </span>alívio).Platipneia(dificuldade <span class="blank _f"> </span>respiratória<span class="blank _1"> </span> <span class="blank _f"> </span>ao <span class="blank _f"> </span>ficar <span class="blank _f"> </span>em <span class="blank _f"> </span>pé<span class="ls1c">, </span></div><div class="t m0 x7 h1 y81 ff1 fs0 fc0 sc0 lsf ws15">Pneumectomia).Trepopneia(melhora <span class="blank _10"> </span>da <span class="blank _10"> </span>respiração <span class="blank _10"> </span>ao <span class="blank _10"> </span>dei<span class="blank _1"> </span>tar <span class="blank _10"> </span>de <span class="blank _10"> </span>lado,Derrame<span class="blank _1"> </span> </div><div class="t m0 x7 h7 y82 ff1 fs0 fc0 sc0 lsf ws5">Pleural).<span class="fs3 ws15"> <span class="fs0">Cheyne S<span class="blank _0"></span>tokes(Síndrome da apneia do sono (apneia seguida de t<span class="blank _0"></span>aquipneia). </span></span></div><div class="t m0 x7 h1 y83 ff1 fs0 fc0 sc0 lsf ws15">Biot(respiração <span class="blank"> </span>alterada/desordenada,LESÃO <span class="blank"> </span>NEUROLÓGICA<span class="ls1a">). <span class="blank"> </span></span>Kus<span class="blank _1"> </span>smaul <span class="blank"> </span>(apneia <span class="blank"> </span>+ </div><div class="t m0 x7 h1 y84 ff1 fs0 fc0 sc0 lsf ws15">inspiração <span class="blank _e"> </span>profunda <span class="blank _d"> </span>e <span class="blank _d"> </span>rápida <span class="blank _e"> </span>+ <span class="blank _d"> </span>apneia <span class="blank _e"> </span>+ <span class="blank"> </span>ex<span class="blank _0"></span>piração <span class="blank _d"> </span>curta <span class="blank _e"> </span>+ <span class="blank"> </span>apneia, <span class="blank _e"> </span>CE<span class="blank _1"> </span>TOACIDOSE </div><div class="t m0 x7 h1 y85 ff1 fs0 fc0 sc0 lsf ws15">DIABÉTICA DESCOMPENSADA<span class="ls1a ws13">).</span> </div><div class="t m0 x7 h3 y86 ff4 fs0 fc3 sc0 lsf ws15">TAQUIPNEIA <span class="blank _9"> </span>E<span class="blank _1"> </span> <span class="blank _e"> </span>HIPERPNEIA<span class="ff1 fc0 ls1f">: <span class="blank"> </span><span class="lsf">Taquipneia <span class="blank _9"> </span>uma <span class="blank _e"> </span>res<span class="blank _1"> </span>piração <span class="blank _9"> </span>superficial <span class="blank _9"> </span>e <span class="blank _e"> </span>acelerada. <span class="blank _e"> </span>A<span class="blank _1"> </span> </span></span></div><div class="t m0 x7 h1 y87 ff1 fs0 fc0 sc0 lsf ws15">hiperpneia, aceleração e int<span class="blank _0"></span>ensificação dos movimentos respiratórios.<span class="blank _1"> </span> </div><div class="t m0 x7 h3 y88 ff4 fs0 fc3 sc0 lsf ws15">TRES <span class="blank _b"> </span>CAUSAS <span class="blank _b"> </span>DE <span class="blank _b"> </span>SIBILO<span class="ff1 fc0">(Asma, <span class="blank _b"> </span>bronquieolite, <span class="blank _b"> </span>infecção <span class="blank _b"> </span>viral<span class="ls1a ws13">),</span></span>TRES <span class="blank _b"> </span>CAUSAS <span class="blank _b"> </span>DE </div><div class="t m0 x7 h3 y89 ff4 fs0 fc3 sc0 lsf ws14">ESTRIDOR<span class="ff1 fc0 ws15">(Amigdalite, dift<span class="blank _0"></span>eria, bronquite<span class="ls1a ws12">).<span class="blank"> </span></span> </span></div><div class="t m0 x7 h3 y8a ff4 fs0 fc4 sc0 lsf ws15">LINFONODOS <span class="blank _c"> </span>OCCIPITAIS<span class="blank _1"> </span><span class="ff1 ls7"> <span class="fc0 lsf">(Drenam <span class="blank _10"> </span>couro <span class="blank _10"> </span>cabel<span class="blank _0"></span>udo <span class="blank _10"> </span>e <span class="blank _10"> </span>pescoço), <span class="blank _10"> </span><span class="ff4 fc4">LINFONODOS </span></span></span></div><div class="t m0 x7 h3 y8b ff4 fs0 fc4 sc0 lsf ws5">RETROAURICULARES<span class="ff1 fc0 ws15">(drenam <span class="blank _a"> </span>couro <span class="blank"> </span>cabeludo), <span class="blank"> </span></span><span class="ws15">LI<span class="blank _1"> </span>NFON<span class="blank _0"></span>ODO <span class="blank _a"> </span>PRÉ-AURICULARES <span class="blank"> </span>E </span></div><div class="t m0 x7 h3 y8c ff4 fs0 fc4 sc0 lsf ws5">PAROTÍDEOS<span class="ff1 fc0">(<span class="fc4 ls8 ws15"> </span><span class="ws15">drenam <span class="blank _e"> </span>região <span class="blank _e"> </span>da <span class="blank _e"> </span>face, <span class="blank _e"> </span>temporal, <span class="blank _e"> </span>glândulas <span class="blank _e"> </span>parótidas <span class="blank _e"> </span>e <span class="blank _e"> </span>bochecha),<span class="blank _1"> </span> </span></span></div><div class="t m0 x7 h3 y8d ff4 fs0 fc4 sc0 lsf ws15">LINFONODOS <span class="blank _11"> </span>SUBMANDIBULARES<span class="blank _1"> </span><span class="ff1 fc0">(drenam <span class="blank _11"> </span>cavidade <span class="blank _11"> </span>oral), <span class="blank _12"> </span></span>LINFONODOS </div><div class="t m0 x7 h3 y8e ff4 fs0 fc4 sc0 lsf ws5">SUBMENTONIANOS<span class="ff1 fc0 ws15">, <span class="blank _13"> </span></span><span class="ws15">LINFONODOS <span class="blank _13"> </span>SUPRACLAVICULARES<span class="ff1 fc0">(drenam <span class="blank _14"> </span>tgi, <span class="blank _13"> </span>trato </span></span></div><div class="t m0 x7 h3 y25 ff1 fs0 fc0 sc0 lsf ws15">geniturinário, pulmão), <span class="blank _1"> </span><span class="ff4 fc4">LINFONODOS <span class="blank _1"> </span>INFRACLAVICULARES</span>(drenam <span class="blank _1"> </span>mama e<span class="blank _1"> </span> <span class="blank _1"> </span>braço), </div><div class="t m0 x7 h3 y8f ff4 fs0 fc4 sc0 lsf ws15">LINFONODOS <span class="blank _1"> </span>AXILARES<span class="blank _1"> </span><span class="ff1 fc0 ls1a">( <span class="blank _1"> </span><span class="lsf">drenem <span class="blank _1"> </span>mama, <span class="blank _1"> </span>extremidade <span class="blank _1"> </span>super<span class="blank _1"> </span>ior <span class="blank _1"> </span>da <span class="blank _1"> </span>parede<span class="blank _1"> </span> <span class="blank _1"> </span>torácica),<span class="blank _1"> </span> </span></span></div><div class="t m0 x7 h3 y90 ff4 fs0 fc4 sc0 lsf ws15">LINFONODOS EPITROCLEANOS<span class="ff1 fc0">(drenam forame ulnar, mãos). </span></div><div class="t m0 x7 h3 y91 ff4 fs0 fc5 sc0 lsf ws15">MANOBRA DE TÓRAX LATERALIZADO<span class="ff1 fc0">(tórax lateralizado e braço estendido para trás </span></div><div class="t m0 x7 h1 y92 ff1 fs0 fc0 sc0 lsf ws15">da <span class="blank _1"> </span>cabeça) <span class="blank _5"> </span>Identificação <span class="blank _1"> </span>de <span class="blank _5"> </span>pa<span class="blank _1"> </span>tologias <span class="blank _1"> </span>da <span class="blank _5"> </span>valva <span class="blank _5"> </span>mitral <span class="blank _5"> </span>irradia<span class="blank _1"> </span>m <span class="blank _1"> </span>para <span class="blank _5"> </span>a <span class="blank _5"> </span>região <span class="blank _5"> </span>axilar<span class="ls20">. </span></div><div class="t m0 x7 h3 y93 ff4 fs0 fc5 sc0 lsf ws15">MANOBRA DE<span class="blank _1"> </span> <span class="blank _1"> </span>TÓRAX <span class="blank _1"> </span>ANTERIORIZADO<span class="ff1 fc0">(tórax <span class="blank _1"> </span>inclinado para <span class="blank _1"> </span>f<span class="blank _1"> </span>rente)Identificação <span class="blank _1"> </span>de </span></div><div class="t m0 x7 h1 y94 ff1 fs0 fc0 sc0 lsf ws15">patologias da va<span class="blank _0"></span>lva aórtica irradiam para as carótidas manobra que verifica<span class="blank _1"> </span> </div><div class="t m0 x7 h3 y95 ff1 fs0 fc0 sc0 lsf ws5">Pericardite<span class="ls13 ws15">. <span class="blank _0"></span><span class="ff4 fc5 lsf">MANOBRA DE <span class="blank _0"></span>VALSALVA<span class="ff1 fc0">(Tapa nariz <span class="blank _0"></span>e boca tentando ex<span class="blank _0"></span>pirar)Aumenta a </span></span></span></div><div class="t m0 x7 h1 y96 ff1 fs0 fc0 sc0 lsf ws15">pressão pulmonar,diminuindo o retorno venoso, diminui todos os sons cardíacos </div><div class="t m0 x7 h1 y97 ff1 fs0 fc0 sc0 lsf ws15">(inclusive <span class="blank _0"></span>os sopros), <span class="blank _0"></span>exceto <span class="blank _0"></span>o <span class="blank _0"></span>som da <span class="blank _6"></span>cardiomiopatia hipertrófica e prol<span class="blank _0"></span>apso da<span class="blank _0"></span> va<span class="blank _0"></span>lva </div><div class="t m0 x7 h7 y98 ff1 fs0 fc0 sc0 lsf ws5">mitral.<span class="fs3 ls9 ws15"> </span><span class="ff4 fc5 ws15">MANOBRA <span class="blank _5"> </span>DE <span class="blank _9"> </span>RIVERO <span class="blank _9"> </span>CARVALLO<span class="blank _1"> </span><span class="ff1 lsa"> </span></span><span class="ws15">(In<span class="blank _0"></span>spira <span class="blank _5"> </span>e <span class="blank _9"> </span>tapa <span class="blank _5"> </span>nariz <span class="blank _9"> </span>e <span class="blank _5"> </span>boca)Aumenta <span class="blank _9"> </span>do </span></div><div class="t m0 x7 h1 y99 ff1 fs0 fc0 sc0 lsf ws15">fluxo sanguíneo para a<span class="blank _0"></span>s câmaras do lado direito e redução da <span class="blank _1"> </span>pressão intratorácica. </div><div class="t m0 x7 h1 y9a ff1 fs0 fc0 sc0 lsf ws15">Aumenta <span class="blank _5"> </span>todos <span class="blank _5"> </span>os<span class="blank _1"> </span> <span class="blank _5"> </span>sons<span class="blank _1"> </span> <span class="blank _5"> </span>à <span class="blank _9"> </span>direita, <span class="blank _5"> </span>menos <span class="blank _9"> </span>o <span class="blank _9"> </span>de <span class="blank _5"> </span>estenose <span class="blank _9"> </span>pulmona<span class="blank _0"></span>r. <span class="blank _9"> </span>Identificaçã<span class="blank _0"></span>o <span class="blank _5"> </span>de<span class="blank _1"> </span> </div><div class="t m0 x7 h8 y9b ff1 fs0 fc0 sc0 lsf ws15">murmúrios <span class="blank _d"> </span>originados <span class="blank _e"> </span>na <span class="blank _d"> </span>valva <span class="blank"> </span>tricúspide<span class="ff4 fc5 lsb">.<span class="fs3 lsc"> </span><span class="lsf">MANOBRA <span class="blank _e"> </span>DE <span class="blank"> </span>HANDGRIP<span class="ff1 lsd"> </span></span></span>Aumenta <span class="blank _d"> </span>o </div><div class="t m0 x7 h7 y9c ff1 fs0 fc0 sc0 lsf ws15">retorno <span class="blank _e"> </span>venoso. <span class="blank _d"> </span>Aumen<span class="blank _1"> </span>to <span class="blank _e"> </span>dos <span class="blank"> </span>sons <span class="blank _e"> </span>va<span class="blank _1"> </span>lvares <span class="blank _e"> </span>à <span class="blank _d"> </span>esquerda.<span class="blank _1"> </span><span class="fs3 lse"> </span><span class="ff4 fc5">M<span class="blank _1"> </span>ANOB<span class="blank _0"></span>RA <span class="blank _e"> </span>DE<span class="blank _1"> </span> <span class="blank _d"> </span>PERNAS </span></div><div class="t m0 x7 h3 y9d ff4 fs0 fc5 sc0 lsf ws15">ELEV<span class="blank _1"> </span>ADAS <span class="blank _b"> </span>OU <span class="blank _10"> </span>AGUAICHADO<span class="ff1 fc0">.Aument<span class="blank _0"></span>a <span class="blank _10"> </span>o <span class="blank _b"> </span>re<span class="blank _1"> </span>torno <span class="blank _c"> </span>venos<span class="blank _1"> </span>o. <span class="blank _10"> </span>A<span class="blank _0"></span>umento <span class="blank _c"> </span>dos <span class="blank _10"> </span>sons </span></div><div class="t m0 x7 h1 y9e ff1 fs0 fc0 sc0 lsf ws15">valvares. </div></div></div><div class="pi" data-data="{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}"></div></div>
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